[大腿前外侧穿流嵌合穿孔肌游离皮瓣移植治疗伴有主动脉损伤的上肢复杂组织缺损的临床效果]。

F Liu, W Q Yan, Q Ma, Y B Liu, Z B Yang
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Three patients had radial artery defects with a length of 4 to 7 cm; two patients had ulnar artery defects with a length of 5 to 8 cm; 4 patients had defects in both ulnar and radial arteries with a length of 3 to 7 cm; and in two patients, the ulnar, radial and brachial arteries were all defective with a length of 4 to 8 cm. The anterolateral thigh flow-through chimeric perforator flap was designed and cut. The skin flap area was from 22 cm×7 cm to 32 cm×11 cm, the chimeric muscle flap area was from 7 cm×4 cm to 10 cm×7 cm, and the length of the flow-through vessel in the \"T\" shaped vessel pedicle was from 4 to 8 cm. When transplanting the skin flap, the proximal end of the vascular pedicle was anastomosed with the proximal end of the recipient site, and the distal end of the vascular pedicle was anastomosed with the more normal blood vessel at the distal end of the forearm; the invalid cavity was filled with the muscle flap. 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引用次数: 0

摘要

目的探讨大腿前外侧穿流嵌合穿孔肌游离皮瓣移植治疗上肢复杂组织缺损伴主动脉损伤的临床效果。研究方法该研究为回顾性观察研究。2019年5月至2022年1月,宁夏医科大学总医院手足踝外科收治符合纳入标准的上肢复杂组织缺损合并主动脉损伤患者11例,其中男7例,女4例,年龄18~56岁。清创后皮肤和软组织缺损面积为 20 cm×6 cm 至 32 cm×10 cm,坏死腔隙或深部组织暴露面积为 7 cm×4 cm 至 10 cm×7 cm。3 名患者的桡动脉缺损长度为 4 至 7 厘米;2 名患者的尺动脉缺损长度为 5 至 8 厘米;4 名患者的尺动脉和桡动脉均缺损,长度为 3 至 7 厘米;2 名患者的尺动脉、桡动脉和肱动脉均缺损,长度为 4 至 8 厘米。设计并切割了大腿前外侧穿流嵌合穿孔皮瓣。皮瓣面积为 22 厘米×7 厘米至 32 厘米×11 厘米,嵌合肌皮瓣面积为 7 厘米×4 厘米至 10 厘米×7 厘米,"T "形血管蒂中的穿流血管长度为 4 厘米至 8 厘米。移植皮瓣时,血管蒂的近端与受体部位的近端吻合,血管蒂的远端与前臂远端较正常的血管吻合,无效腔隙由肌皮瓣填充。组织瓣供区伤口直接缝合或植皮处理。术后观察皮瓣的供血和存活情况、远端肢体的存活情况以及皮瓣供体部位植皮的存活情况。术后 2 至 4 周进行了计算机断层扫描血管造影术(CTA),以观察近端和远端吻合动脉的通畅情况。在随访期间,观察了皮瓣的质地、移植皮肤的存活率以及供区的愈合情况。结果:一名患者(前臂完全断开)在术后 5 天出现肢体远端血液紊乱。CTA 检查提示穿支动脉远端吻合处栓塞。因此,最终进行了截肢手术。其余10名患者的皮瓣均未发生血管危象,所有皮瓣、远端肢体和皮瓣供体部位的植皮均存活良好。术后 2 至 4 周,吻合动脉的近端和远端通畅良好。随访11-37个月,皮瓣质地良好,所有供皮部位伤口愈合良好。结论使用大腿前外侧穿支嵌合打孔肌皮瓣修复伴有主动脉损伤的上肢复杂组织缺损,可提高肢体挽救的成功率,可在临床实践中推广。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Clinical effect of anterolateral thigh flow-through chimeric perforator free flap transplantation in the treatment of upper limb complex tissue defects with main artery injury].

Objective: To investigate the clinical effect of anterolateral thigh flow-through chimeric perforator free flap transplantation in the treatment of upper limb complex tissue defects with main artery injury. Methods: The study was a retrospective observational study. From May 2019 to January 2022, 11 patients with upper limb complex tissue defects combined with main artery injury who met the inclusion criteria were admitted to the Department of Hand, Foot and Ankle Surgery of General Hospital of Ningxia Medical University, including 7 males and 4 females, aged from 18 to 56 years. After debridement, the area of skin and soft tissue defects was from 20 cm×6 cm to 32 cm×10 cm, and the exposed area of dead cavity or deep tissue was from 7 cm×4 cm to 10 cm×7 cm. Three patients had radial artery defects with a length of 4 to 7 cm; two patients had ulnar artery defects with a length of 5 to 8 cm; 4 patients had defects in both ulnar and radial arteries with a length of 3 to 7 cm; and in two patients, the ulnar, radial and brachial arteries were all defective with a length of 4 to 8 cm. The anterolateral thigh flow-through chimeric perforator flap was designed and cut. The skin flap area was from 22 cm×7 cm to 32 cm×11 cm, the chimeric muscle flap area was from 7 cm×4 cm to 10 cm×7 cm, and the length of the flow-through vessel in the "T" shaped vessel pedicle was from 4 to 8 cm. When transplanting the skin flap, the proximal end of the vascular pedicle was anastomosed with the proximal end of the recipient site, and the distal end of the vascular pedicle was anastomosed with the more normal blood vessel at the distal end of the forearm; the invalid cavity was filled with the muscle flap. The donor site wounds of tissue flap were closed directly or treated with skin grafting. After operation, the blood supply and survival of the flap, the survival of the distal limb, and the survival of the skin graft at the flap donor site were observed. Computed tomography angiography (CTA) was performed to observe the patency of the proximal and distal anastomotic arteries from 2 to 4 weeks after surgery. During follow-up, the texture of the flap, the survival of the grafted skin and the healing of the donor area were observed. Results: One patient (complete forearm disconnection) developed distal limb blood disorder on 5 days after surgery. CTA examination suggested embolization of the distal anastomosis of the flow-through artery. more muscle and skin and soft tissue necrosis of the distal limb showed in emergency exploration. So, amputation was performed ultimately. No vascular crisis occurred in the skin flaps of the remaining 10 patients, and all skin flaps, distal limbs and the skin grafts in flap donor sites survived well. Two to 4 weeks after surgery, the proximal and distal ends of the anastomosed arteries were good in the patency. Follow-up for 11-37 months, the flap texture was good, and all donor site wounds healed well. Conclusions: The use of anterolateral thigh flow-through chimeric perforator flap to repair upper limb complex tissue defects accompanied by main artery injury can improve the success rate of limb salvage, which can be promoted in clinical practice.

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